Pseudomonas in drinking water: a risk in hospitals

Pseudomonas aeruginosa is one of the most significant bacteria in drinking water. It thrives in damp spots, building up in the biofilm at the very end of the line: the aerators, shower hoses and shower heads. It is highly relevant for immunosuppressed patients, and the Legionella test does not detect it.

At a glance

  • Limit value: not detectable, 0 CFU/100 ml (recommendation of the Drinking Water Commission at the UBA)
  • Legal status: not a mandatory TrinkwV parameter, tested only on a case-by-case basis
  • Distinction: not part of the routine Legionella test (Legionella: Annex 3 Part II TrinkwV)
  • Detection: by culture in accordance with DIN EN ISO 16266, from a 100 ml sample
  • Clinical relevance: above all immunosuppressed patients, a common cause of nosocomial infections
Water streaming from a shower head, the typical habitat of Pseudomonas aeruginosa
Pseudomonas aeruginosa prefers to settle in shower heads, hoses and aerators, that is the last few centimetres before the outlet.

Where Pseudomonas takes hold

Unlike Legionella, which mainly arises in the distribution system and the hot water tank, Pseudomonas prefers to colonise the last few centimetres before the outlet. Aerators, flow regulators, shower hoses and shower heads give it damp, leftover water and a surface to cling to.

Pseudomonas and Legionella compared

Legionella spp.Pseudomonas aeruginosa
Main locationHot water tank, distribution systemPoint-of-use fittings, aerators
Temperature optimum25 to 45 °C30 to 37 °C, also tolerates colder temperatures
TransmissionAerosol, inhalationContact, wounds, aerosol
Mandatory TrinkwV testingyes, § 31no, only case-by-case
RequirementAction value 100 CFU/100 mlnot detectable, under 1 CFU/100 ml
Main risk groupOlder people, those with pre-existing conditions, smokersImmunosuppressed, wounds, catheters

Based on the Drinking Water Ordinance (§ 31 TrinkwV), the German Environment Agency (UBA) and the KRINKO recommendations of the Robert Koch Institute. Own illustration.

How Pseudomonas is detected

Detection is carried out by culture from a 100 ml water sample in accordance with DIN EN ISO 16266. Because Pseudomonas is not part of the annual Legionella test, sampling must be commissioned specifically, usually on suspicion, after a cluster of infections or as part of a hygiene plan. Sampling focuses above all on the outlets in high-risk areas, because that is exactly where the bacterium sits.

Why it is especially critical in hospitals

Pseudomonas is one of the most common causes of nosocomial (hospital-acquired) infections. In patients with open wounds, catheters or mechanical ventilation, even low bacterial counts are enough. To make matters worse, many strains are resistant to several antibiotics, which makes treatment considerably harder.

What helps against colonisation

Regular water exchange prevents residual water from standing for days in components at the outlet, since standing residual water favours colonisation. In addition, shower heads and aerators in high-risk areas belong in a fixed replacement and cleaning cycle.

In very high-risk areas such as transplant or intensive care units, terminal sterile filters are also used, holding the bacterium back directly at the outlet. Thermal disinfection of the distribution system alone, on the other hand, is often not enough, because it does not reach the components at the outlet adequately.

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Frequently asked questions

Is Pseudomonas aeruginosa regulated under the Drinking Water Ordinance?

Pseudomonas aeruginosa is not a mandatory parameter of routine testing and is not on the list of indicator parameters in Annex 3 of the TrinkwV. Testing is carried out on a case-by-case basis; in medical facilities it is based on the recommendation of the German Environment Agency and the KRINKO recommendations.

Is heating enough against Pseudomonas?

Only to a limited extent. The bacterium sits in components at the outlet such as aerators and shower heads, which thermal disinfection of the distribution system often does not reach adequately. We describe the procedure in detail under Legionella and thermal disinfection; against Pseudomonas, cleaning and replacing the components remains necessary.

How often should shower heads and aerators be replaced?

There is no legally fixed cycle. In high-risk areas the hygiene plan sets the cleaning and replacement intervals, agreed with the hospital hygiene team. It is also important that the components are not left unused for days on end with residual water in them, since stagnation encourages colonisation.

What limit value applies to Pseudomonas aeruginosa?

According to the recommendation of the Drinking Water Commission at the German Environment Agency, Pseudomonas aeruginosa should not be detectable in drinking water, meaning fewer than 1 CFU per 100 ml. Unlike the Legionella action value, there is no tolerance level here. Culture-based detection is carried out in accordance with DIN EN ISO 16266.

Does Pseudomonas need to be tested for in residential buildings?

In normal residential buildings, no routine testing for Pseudomonas aeruginosa is planned. Case-by-case sampling mainly concerns sensitive areas such as hospitals and care homes. We explain the scope and process of sampling under the basics of Legionella testing.